Bone augmentation utilizing muscle-derived progenitor compositions in biocompatible matrix, and treatments thereof

ABSTRACT

The present invention provides muscle-derived progenitor cells that show long-term survival following transplantation into body tissues and which can augment non-soft tissue following introduction (e.g. via injection, transplantation, or implantation) into a site of non-soft tissue (e.g. bone) when combined with a biocompatible matrix, preferably SIS. The invention further provides methods of using compositions comprising muscle-derived progenitor cells with a biocompatible matrix for the augmentation and bulking of mammalian, including human, bone tissues in the treatment of various functional conditions, including osteoporosis, Paget&#39;s Disease, osteogenesis imperfecta, bone fracture, osteomalacia, decrease in bone trabecular strength, decrease in bone cortical strength and decrease in bone density with old age.

RELATED APPLICATIONS

This application claims priority to and is a continuation of U.S. patentapplication Ser. No. 16/293,041, filed on Mar. 5, 2019, which claimspriority to and is a continuation of U.S. patent application Ser. No.14/499,853, filed on Sep. 29, 2014, which claims priority to and is acontinuation of U.S. patent application Ser. No. 12/543,311, filed onAug. 18, 2009 (now U.S. Pat. No. 9,199,003), which claims priority fromU.S. Provisional Patent Applications 61/089,798, filed on Aug. 18, 2008,and 61/166,775, filed on Apr. 6, 2009, each of which is incorporated byreference, herein, in their entireties for all purposes.

GOVERNMENT INTERESTS

This invention was made with Government support under Grant No.R01-DE13420-01 awarded by the National Institutes of Health. TheGovernment has certain rights in this invention.

FIELD OF THE INVENTION

The present invention relates to muscle-derived progenitor cells (MDCs)and compositions of MDCs with biologically compatible matrix and theiruse with the augmentation of body tissues, particularly bone. Inparticular, the present invention relates to muscle-derived progenitorcells that show long-term survival following introduction into bone usedin combination with small intestine sub-mucosa for the augmentation ofhuman or animal bone. The invention also relates to novel uses ofmuscle-derived progenitor cells with biologically compatible matrix forthe treatment of cosmetic or functional conditions, such asosteoporosis, Paget's Disease, osteogenesis imperfecta, bone fracture,osteomalacia, decrease in bone trabecular strength, decrease in bonecortical strength and decrease in bone density with old age. Theinvention also relates to the novel use of MDCs with biologicallycompatible matrix for the increase of bone mass in athletes or otherorganisms in need of greater than average bone mass.

BACKGROUND OF THE INVENTION

Myoblasts, the precursors of muscle fibers, are mononucleated musclecells that fuse to form post-mitotic multinucleated myotubes, which canprovide long-term expression and delivery of bioactive proteins (T. A.Partridge and K. E. Davies, 1995, Brit. Med. Bulletin 51:123 137; J.Dhawan et al., 1992, Science 254: 1509 12; A. D. Grinnell, 1994, MyologyEd 2, A. G. Engel and C. F. Armstrong, McGraw-Hill, Inc., 303 304; S.Jiao and J. A. Wolff, 1992, Brain Research 575:143 7; H. Vandenburgh,1996, Human Gene Therapy 7:2195 2200).

Cultured myoblasts contain a subpopulation of cells that show some ofthe self-renewal properties of stem cells (A. Baroffio et al., 1996,Differentiation 60:47 57). Such cells fail to fuse to form myotubes, anddo not divide unless cultured separately (A. Baroffio et al., supra).Studies of myoblast transplantation (see below) have shown that themajority of transplanted cells quickly die, while a minority survive andmediate new muscle formation (J. R. Beuchamp et al., 1999, J. Cell Biol.144:1113 1122). This minority of cells shows distinctive behavior,including slow growth in tissue culture and rapid growth followingtransplantation, suggesting that these cells may represent myoblast stemcells (J. R. Beuchamp et al., supra).

Myoblasts have been used as vehicles for gene therapy in the treatmentof various muscle- and non-muscle-related disorders. For example,transplantation of genetically modified or unmodified myoblasts has beenused for the treatment of Duchenne muscular dystrophy (E. Gussoni etal., 1992, Nature, 356:435 8; J. Huard et al., 1992, Muscle & Nerve,15:550 60; G. Karpati et al., 1993, Ann. Neurol., 34:8 17; J. P.Tremblay et al., 1993, Cell Transplantation, 2:99 112; P. A. Moisset etal., 1998, Biochem. Biophys. Res. Commun. 247:94 9; P. A. Moisset etal., 1998, Gene Ther. 5:1340 46). In addition, myoblasts have beengenetically engineered to produce proinsulin for the treatment of Type 1diabetes (L. Gros et al., 1999, Hum. Gen. Ther. 10:1207 17); Factor IXfor the treatment of hemophilia B (M. Roman et al., 1992, Somat. Cell.Mol. Genet. 18:247 58; S. N. Yao et al., 1994, Gen. Ther. 1:99 107; J.M. Wang et al., 1997, Blood 90:1075 82; G. Hortelano et al., 1999, Hum.Gene Ther. 10:1281 8); adenosine deaminase for the treatment ofadenosine deaminase deficiency syndrome (C. M. Lynch et al., 1992, Proc.Natl. Acad. Sci. USA, 89:1138 42); erythropoietin for the treatment ofchronic anemia (E. Regulier et al., 1998, Gene Ther. 5:1014 22; B. Dalleet al., 1999, Gene Ther. 6:157 61), and human growth hormone for thetreatment of growth retardation (K. Anwer et al., 1998, Hum. Gen. Ther.9:659 70).

Myoblasts have also been used to treat muscle tissue damage or disease,as disclosed in U.S. Pat. No. 5,130,141 to Law et al., U.S. Pat. No.5,538,722 to Blau et al., and application U.S. Ser. No. 09/302,896 filedApr. 30, 1999 by Chancellor et al. In addition, myoblast transplantationhas been employed for the repair of myocardial dysfunction (C. E. Murryet al., 1996, J. Clin. Invest. 98:2512 23; B. Z. Atkins et al., 1999,Ann. Thorac. Surg. 67:124 129; B. Z. Atkins et al., 1999, J. Heart LungTransplant. 18:1173 80).

In spite of the above, in most cases, primary myoblast-derivedtreatments have been associated with low survival rates of the cellsfollowing transplantation due to migration and/or phagocytosis. Tocircumvent this problem, U.S. Pat. No. 5,667,778 to Atala discloses theuse of myoblasts suspended in a liquid polymer, such as alginate. Thepolymer solution acts as a matrix to prevent the myoblasts frommigrating and/or undergoing phagocytosis after injection. However, thepolymer solution presents the same problems as the biopolymers discussedabove. Furthermore, the Atala patent is limited to uses of myoblasts inonly muscle tissue, but no other tissue.

Thus, there is a need for other, different tissue augmentation materialsthat are long-lasting, compatible with a wide range of host tissues, andwhich cause minimal inflammation, scarring, and/or stiffening of thetissues surrounding the implant site. Accordingly, the muscle-derivedprogenitor cell (MDC)-containing compositions of the present inventionare provided as improved and novel materials for augmenting bone.Further provided are methods of producing muscle-derived progenitor cellcompositions that show long-term survival following transplantation, andmethods of utilizing MDCs and compositions containing MDCs to treatvarious aesthetic and/or functional defects, including, for exampleosteoporosis, Paget's Disease, osteogenesis imperfecta, bone fracture,osteomalacia, decrease in bone trabecular strength, decrease in bonecortical strength and decrease in bone density with old age. Alsoprovided are methods of using MDCs and compositions containing MDCs forthe increase of bone mass in athletes or other organisms in need ofgreater than average bone mass.

It is notable that prior attempts to use myoblasts for non-muscle tissueaugmentation were unsuccessful (U.S. Pat. No. 5,667,778 to Atala).Therefore, the findings disclosed herein are unexpected, as they showthat the muscle-derived progenitor cells according to the presentinvention can be successfully transplanted into non-muscle tissue,including bone tissue, and exhibit long-term survival. As a result, MDCsand compositions comprising MDCs can be used as a general augmentationmaterial for bone production. Moreover, since the muscle-derivedprogenitor cells and compositions of the present invention can bederived from autologous sources, they carry a reduced risk ofimmunological complications in the host, including the reabsorption ofaugmentation materials, and the inflammation and/or scarring of thetissues surrounding the implant site.

Although mesenchymal stem cells can be found in various connectivetissues of the body including muscle, bone, cartilage, etc. (H. E. Younget al., 1993, In vitro Cell Dev. Biol. 29A:723 736; H. E. Young, et al.,1995, Dev. Dynam. 202:137 144), the term mesenchymal has been usedhistorically to refer to a class of stem cells purified from bonemarrow, and not from muscle. Thus, mesenchymal stem cells aredistinguished from the muscle-derived progenitor cells of the presentinvention. Moreover, mesenchymal cells do not express the CD34 cellmarker (M. F. Pittenger et al., 1999, Science 284:143 147), which isexpressed by the muscle-derived progenitor cells described herein.

SIS is an acellular, naturally occurring collagenous extracellularmatrix material derived from the submucosa of porcine small intestine,which contains bioactive molecules (TGF-β, bFGF) (Voytik-Harbin S, etal. J Cell Biochem, 1997). While SIS is primarily used for the repair ofsoft tissues, its potential as a bone graft material is still underdebate. Only a few studies reported that SIS had potential for boneregeneration (Suckow M, et al. J Invest Surg, 1999, Voytik-Harbin S, etal. Trans First SIS Symposium, 1996). Most recent report from Moore D,et al. J Biomed Mater Res, 2004 suggests that SIS is not capable ofinducing or conducting new bone formation across a critical sizesegmental bone defect.

Moreover, current methods of producing cell matrices for in vivo tissueand organ repair are very costly and time consuming. Such cell matricesare costly due to the specialized factories and/or procedures needed toproduce these products. Also, since cell-matrix products involve livingbiological cells/tissue, a tremendous loss of product occurs fromshipping, the delays associated therewith, and the like. Additionally,given the nature of the products, obtaining regulatory approval for newproducts that are based on living cells and a new matrix posesdifficulties.

Thus, there is a serious need for cell-matrix compositions that are lowin cost, that are versatile, and easily prepared and/or manufactured.There is a further need for cell matrix compositions that do not requireextensive in vitro incubation or cultivation periods after the cellshave been incorporated into the matrix. Those in the art have recognizedthat a major problem remaining to be solved is the delay in producingthe cell-matrix product after initial preparation. Specifically, it hasbeen stated that there is a problem of a three week delay necessary toproduce a sufficient amount of autologous keratinocytes and fibroblastsfor the production of reconstructed skin. (F. Berthod and O. Damour,1997, British Journal of Dermatology, 136: 809-816). The presentinvention provides a solution for the above-mentioned problems anddelays currently extant in the art.

The description herein of disadvantages and problems associated withknown compositions, and methods is in no way intended to limit the scopeof the embodiments described in this document to their exclusion.Indeed, certain embodiments may include one or more known compositions,compounds, or methods without suffering from the so-noted disadvantagesor problems.

SUMMARY OF THE INVENTION

It is an object of the present invention to provide uses for MDCs andcompositions comprising MDCs with biologically compatible matrix for theaugmentation of non-muscle tissue, including bone, without the need forpolymer carriers or special culture media for transplantation. Such usesinclude the administration of MDC compositions with biologicallycompatible matrix by introduction into bone, for example by directinjection into or on the surface of the tissue, wherein the tissue asbeen previously administered a biologically compatible matrix.Preferably, this matrix is small intestine submucosa (SIS).

It is yet another object of the present invention to provide uses forMDCs for augmenting bone, following injury, wounding, surgeries,traumas, non-traumas, or other procedures that result in fissures,openings, depressions, wounds, and the like.

The invention provides the use of SIS seeded with MDCs for treating abone disease, defect or pathology or improving at least one symptomassociated with a bone disease, defect or pathology in a mammaliansubject in need thereof wherein the MDCs are isolated from skeletalmuscle, wherein the MDCs express desmin and wherein the MDCs are able toform bone tissue. In one embodiment, the MDC seeded SIS is administeredby applying it to the surface of the bone. In another embodiment, theMDC seeded SIS is positioned in the interior of the bone. In anotherembodiment, the mammal is a human. In some embodiments, the symptom isselected from the group consisting of decreased bone density anddecreased bone mass.

In another specific embodiment, the MDCs are cultured to expand theirnumber before being used to seed the SIS. Preferably, the MDCs arefrozen to a temperature below −30° C. after being cultured to expandtheir number and thawed prior to being used to seed SIS.

In another embodiment, the skeletal muscle cells are isolated from thehuman subject before the bone disease, defect or pathology begins in thehuman subject. Preferably, when the bone defect, disease or pathology isa bone defect the bone defect is a bone fracture caused by trauma.

In other preferred embodiments, the MDCs are isolated by a methodcomprising: isolating skeletal muscle cells from a mammal, suspendingthe mammalian skeletal muscle cells in a first cell culture containerfor between 30 and 120 minutes; decanting the media from the first cellculture container to a second cell culture container; allowing theremaining cells in the media to attach to the walls of the second cellculture container; isolating the cells from the walls of the second cellculture container, wherein the isolated cells are MDCs; providing smallintestine submucosa (SIS); seeding the SIS with MDCs; and administeringthe MDC seeded SIS to a bone suffering from the bone defect, disease orpathology of the mammalian subject.

Preferably, the mammalian skeletal muscle cells are cooled to atemperature below 10° C. and stored for 1-7 days after being isolatedand before being suspended in a first cell culture container between 30and 120 minutes

In other preferred embodiments, the MDCs are isolated by a methodcomprising: plating a suspension of skeletal muscle cells from mammalianskeletal muscle tissue in a first container to which fibroblast cells ofthe skeletal muscle cell suspension adhere, re-plating non-adherentcells from step (a) in a second container, wherein the step ofre-plating is after 15-20% of cells have adhered to the first container;repeating step (b) at least once; and isolating the non-adherent cellswherein the isolated cells are MDCs; providing small intestine submucosa(SIS); seeding the SIS with MDCs; and administering the MDC seeded SISto a bone suffering from the bone defect, disease or pathology of themammalian subject.

Additional objects and advantages afforded by the present invention willbe apparent from the detailed description and exemplificationhereinbelow.

BRIEF DESCRIPTION OF THE DRAWINGS

The appended drawings of the figures are presented to further describethe invention and to assist in its understanding through clarificationof its various aspects.

FIG. 1 shows 3D reconstruction of untreated (A,D), SIS-treated (B,E) andSIS-hMDC-treated (C,F) calvarial defects at 4 weeks (A,B,C) and 10 weeks(D,E,F) after surgery.

FIG. 2 is a bar graph showing new bone formation in calvarial defects at4 and 10 weeks.

FIG. 3 is a bar graph showing a bone bridging score for mice treatedwith SIS with and without MDCs at 4 and 10 weeks.

FIG. 4A is a bar graph showing the volume of bone matrix formation onSIS with and without hMDCs and with osteogenic or proliferation medium(OSM and PM, respectively) at 7, 10, 14, 21 and 28 days.

FIG. 4B is a bar graph showing the density of bone matrix formation onSIS with and without hMDCs and with OSM or PM at 7, 10, 14, 21 and 28days.

FIG. 5 is a 3D reconstruction of the SIS with and without hMDCs and withOSM or PM at 28 days.

FIG. 6A is a bar graph showing the volume of bone matrix formation oncell pellets at 7, 10, 14, 21 and 28 days.

FIG. 6B is a bar graph showing the density of bone matrix formation oncell pellets at 7, 10, 14, 21 and 28 days.

DETAILED DESCRIPTION OF THE INVENTION

The invention provides methods of treating bone disorders includingincontinence osteoporosis, Paget's Disease, osteogenesis imperfecta,bone fracture, osteomalacia, decrease in bone trabecular strength,decrease in bone cortical strength and decrease in bone density with oldage. The isolation of human muscle-derived cells (MDCs) from adulttissue are capable of achieving increased bone density and bone volumewithin human subjects administered these cells in combination with abiologically compatible matrix.

Muscle-Derived Cells and Compositions

The present invention provides MDCs comprised of early progenitor cells(also termed muscle-derived progenitor cells or muscle-derived stemcells herein) that show long-term survival rates followingtransplantation into body tissues, preferably bone. To obtain the MDCsof this invention, a muscle explant, preferably skeletal muscle, isobtained from an animal donor, preferably from a mammal, includinghumans. This explant serves as a structural and functional syncytiumincluding “rests” of muscle precursor cells (T. A. Partridge et al.,1978, Nature 73:306 8; B. H. Lipton et al., 1979, Science 205:12924).

Cells isolated from primary muscle tissue contain mixture offibroblasts, myoblasts, adipocytes, hematopoietic, and muscle-derivedprogenitor cells. The progenitor cells of a muscle-derived populationcan be enriched using differential adherence characteristics of primarymuscle cells on collagen coated tissue flasks, such as described in U.S.Pat. No. 6,866,842 of Chancellor et al. Cells that are slow to adheretend to be morphologically round, express high levels of desmin, andhave the ability to fuse and differentiate into multinucleated myotubesU.S. Pat. No. 6,866,842 of Chancellor et al.). A subpopulation of thesecells was shown to respond to recombinant human bone morphogenic protein2 (rhBMP-2) in vitro by expressing increased levels of alkalinephosphatase, parathyroid hormone dependent 3′,5′-cAMP, and osteogeniclineage and myogenic lineages (U.S. Pat. No. 6,866,842 of Chancellor etal.; T. Katagiri et al., 1994, J. Cell Biol., 127:1755 1766).

In one embodiment of the invention, a preplating procedure may be usedto differentiate rapidly adhering cells from slowly adhering cells(MDCs). In accordance with the present invention, populations of rapidlyadhering MDC (PP1-4) and slowly adhering, round MDC (PP6) were isolatedand enriched from skeletal muscle explants and tested for the expressionof various markers using immunohistochemistry to determine the presenceof pluripotent cells among the slowly adhering cells (Example 1; patentapplication U.S. Ser. No. 09/302,896 of Chancellor et al.). As shown inTable 2, Example 3 herein, the PP6 cells expressed myogenic markers,including desmin, MyoD, and Myogenin. The PP6 cells also expressed c-metand MNF, two genes which are expressed at an early stage of myogenesis(J. B. Miller et al., 1999, Curr. Top. Dev. Biol. 43:191 219; see Table3). The PP6 showed a lower percentage of cells expressing M-cadherin, asatellite cell-specific marker (A. Irintchev et al., 1994, DevelopmentDynamics 199:326 337), but a higher percentage of cells expressingBcl-2, a marker limited to cells in the early stages of myogenesis (J.A. Dominov et al., 1998, J. Cell Biol. 142:537 544). The PP6 cells alsoexpressed CD34, a marker identified with human hematopoietic progenitorcells, as well as stromal cell precursors in bone marrow (R. G. Andrewset al., 1986, Blood 67:842 845; C. I. Civin et al., 1984, J. Immunol.133:157 165; L. Fina et al, 1990, Blood 75:2417 2426; P. J. Simmons etal., 1991, Blood 78:2848 2853; see Table 3). The PP6 cells alsoexpressed Flk-1, a mouse homologue of human KDR gene which was recentlyidentified as a marker of hematopoietic cells with stem cell-likecharacteristics (B. L. Ziegler et al., 1999, Science 285:1553 1558; seeTable 3). Similarly, the PP6 cells expressed Sca-1, a marker present inhematopoietic cells with stem cell-like characteristics (M. van de Rijnet al., 1989, Proc. Natl. Acad. Sci. USA 86:4634 8; M. Osawa et al.,1996, J. Immunol. 156:3207 14; see Table 3). However, the PP6 cells didnot express the CD45 or c-Kit hematopoietic stem cell markers (reviewedin L K. Ashman, 1999, Int. J. Biochem. Cell. Biol. 31:1037 51; G. A.Koretzky, 1993, FASEB J. 7:420 426; see Table 3).

In one embodiment of the present invention is the PP6 population ofmuscle-derived progenitor cells having the characteristics describedherein. These muscle-derived progenitor cells express the desmin, CD34,and Bcl-2 cell markers. In accordance with the present invention, thePP6 cells are isolated by the techniques described herein (Example 1) toobtain a population of muscle-derived progenitor cells that havelong-term survivability following transplantation. The PP6muscle-derived progenitor cell population comprises a significantpercentage of cells that express progenitor cell markers such as desmin,CD34, and Bcl-2. In addition, PP6 cells express the Flk-1 and Sca-1 cellmarkers, but do not express the CD45 or c-Kit markers. Preferably,greater than 95% of the PP6 cells express the desmin, Sca-1, and Flk-1markers, but do not express the CD45 or c-Kit markers. It is preferredthat the PP6 cells are utilized within about 1 day or about 24 hoursafter the last plating.

In a preferred embodiment, the rapidly adhering cells and slowlyadhering cells (MDCs) are separated from each other using a singleplating technique. One such technique is described in Example 2. First,cells are provided from a skeletal muscle biopsy. The biopsy need onlycontain about 100 mg of cells. Biopsies ranging in size from about 50 mgto about 500 mg are used according to both the pre-plating and singleplating methods of the invention. Further biopsies of 50, 100, 110, 120,130, 140, 150, 200, 250, 300, 400 and 500 mg are used according to boththe pre-plating and single plating methods of the invention.

In a preferred embodiment of the invention, the tissue from the biopsyis then stored for 1 to 7 days. This storage is at a temperature fromabout room temperature to about 4° C. This waiting period causes thebiopsied skeletal muscle tissue to undergo stress. While this stress isnot necessary for the isolation of MDCs using this single platetechnique, it seems that using the wait period results in a greateryield of MDCs.

According to preferred embodiments, tissue from the biopsies is mincedand centrifuged. The pellet is resuspended and digested using adigestion enzyme. Enzymes that may be used include collagenase, dispaseor combinations of these enzymes. After digestion, the enzyme is washedoff of the cells. The cells are transferred to a flask in culture mediafor the isolation of the rapidly adhering cells. Many culture media maybe used. Particularly preferred culture media include those that aredesigned for culture of endothelial cells including Cambrex EndothelialGrowth Medium. This medium may be supplemented with other componentsincluding fetal bovine serum, IGF-1, bFGF, VEGF, EGF, hydrocortisone,heparin, and/or ascorbic acid. Other media that may be used in thesingle plating technique include InCell M310F medium. This medium may besupplemented as described above, or used unsupplemented.

The step for isolation of the rapidly adhering cells may require culturein flask for a period of time from about 30 to about 120 minutes. Therapidly adhering cells adhere to the flask in 30, 40, 50, 60, 70, 80,90, 100, 110 or 120 minutes. After they adhere, the slowly adheringcells are separated from the rapidly adhering cells from removing theculture media from the flask to which the rapidly adhering cells areattached to.

The culture medium removed from this flask is then transferred to asecond flask. The cells may be centrifuged and resuspended in culturemedium before being transferred to the second flask. The cells arecultured in this second flask for between 1 and 3 days. Preferably, thecells are cultured for two days. During this period of time, the slowlyadhering cells (MDCs) adhere to the flask. After the MDCs have adhered,the culture media is removed and new culture media is added so that theMDCs can be expanded in number. The MDCs may be expanded in number byculturing them for from about 10 to about 20 days. The MDCs may beexpanded in number by culturing them for 10, 11, 12, 13, 14, 15, 16, 17,18, 19 or 20 days. Preferably, the MDCs are subject to expansion culturefor 17 days.

As an alternative to the pre-plating and single plating methods, theMDCs of the present invention can be isolated by fluorescence-activatedcell sorting (FACS) analysis using labeled antibodies against one ormore of the cell surface markers expressed by the MDCs (C. Webster etal., 1988, Exp. Cell. Res. 174:252 65; J. R. Blanton et al., 1999,Muscle Nerve 22:43 50). For example, FACS analysis can be performedusing labeled antibodies that specifically bind to CD34, Flk-1, Sca-1,and/or the other cell-surface markers described herein to select apopulation of PP6-like cells that exhibit long-term survivability whenintroduced into the host tissue. Also encompassed by the presentinvention is the use of one or more fluorescence-detection labels, forexample, fluorescein or rhodamine, for antibody detection of differentcell marker proteins.

Using any of the MDCs isolation methods described above, MDCs that areto be transported, or are not going to be used for a period of time maybe preserved using methods known in the art. More specifically, theisolated MDCs may be frozen to a temperature ranging from about −25 toabout −90° C. Preferably, the MDCs are frozen at about −80° C., on dryice for delayed use or transport. The freezing may be done with anycryopreservation medium known in the art.

Muscle-Derived Cell-Based Treatments

In one embodiment of the present invention, the MDCs are isolated from askeletal muscle source and introduced or transplanted into a muscle ornon-muscle soft tissue site of interest, or into bone structures.Advantageously, the MDCs of the present invention are isolated andenriched to contain a large number of progenitor cells showing long-termsurvival following transplantation. In addition, the muscle-derivedprogenitor cells of this invention express a number of characteristiccell markers, such desmin, CD34, and Bcl-2. Furthermore, themuscle-derived progenitor cells of this invention express the Sca-1, andFlk-1 cell markers, but do not express the CD45 or c-Kit cell markers(see Example 1).

MDCs and compositions comprising MDCs of the present invention can beused to repair, treat, or ameliorate various aesthetic or functionalconditions (e.g. defects) through the augmentation of bone. Inparticular, such compositions can be used for the treatment of bonedisorders. Multiple and successive administrations of MDC are alsoembraced by the present invention.

For MDC-based treatments, a skeletal muscle explant is preferablyobtained from an autologous or heterologous human or animal source. Anautologous animal or human source is more preferred. MDC compositionsare then prepared and isolated as described herein. To introduce ortransplant the MDCs and/or compositions comprising the MDCs according tothe present invention into a human or animal recipient, a suspension ofmononucleated muscle cells is prepared. Such suspensions containconcentrations of the muscle-derived progenitor cells of the inventionin a physiologically-acceptable carrier, excipient, or diluent. Forexample, suspensions of MDC for administering to a subject can comprise10⁸ to 10⁹ cells/ml in a sterile solution of complete medium modified tocontain the subject's serum, as an alternative to fetal bovine serum.Alternatively, MDC suspensions can be in serum-free, sterile solutions,such as cryopreservation solutions (Celox Laboratories, St. Paul,Minn.). The MDC suspensions can then be introduced e.g., via injection,into one or more sites of the donor tissue.

In certain embodiments, the described cells are administered as apharmaceutically or physiologically acceptable preparation orcomposition containing a physiologically acceptable carrier, excipient,or diluent, and administered to the tissues of the recipient organism ofinterest, including humans and non-human animals. In other embodiments,the MDC-containing composition are prepared by resuspending the cells ina suitable liquid or solution such as sterile physiological saline orother physiologically acceptable injectable aqueous liquids. The amountsof the components to be used in such compositions can be routinelydetermined by those having skill in the art.

According to the invention, the MDCs or compositions thereof can beadministered by placement of the MDC suspensions onto a biocompatiblematrix, e.g., small intestine submucosa (SIS). In some embodiments, theMDCs are inserted into the biocompatible matrix and then theMDC-containing matrix into or onto the site of interest. Alternatively,the MDCs can be administered by parenteral routes of injection,including subcutaneous, intravenous, intramuscular, and intrasternal tothe desired tissue that has already been administered the biocompatiblematerial.

To optimize transplant success, the closest possible immunological matchbetween donor and recipient is desired. If an autologous source is notavailable, donor and recipient Class I and Class II histocompatibilityantigens can be analyzed to determine the closest match available. Thisminimizes or eliminates immune rejection and reduces the need forimmunosuppressive or immunomodulatory therapy. If required,immunosuppressive or immunomodulatory therapy can be started before,during, and/or after the transplant procedure. For example, cyclosporinA or other immunosuppressive drugs can be administered to the transplantrecipient. Immunological tolerance may also be induced prior totransplantation by alternative methods known in the art (D. J. Watt etal., 1984, Clin. Exp. Immunol. 55:419; D. Faustman et al., 1991, Science252:1701).

Consistent with the present invention, the MDCs can be administered tobody tissues, including bone in the presence of a biocompatible matrix.The number of cells in an MDC suspension and the mode of administrationmay vary depending on the site and condition being treated. From about1.0×10⁵ to about 1×10⁸ MDCs may be administered according to theinvention. As a non-limiting example, in accordance with the presentinvention, about 0.5-3.0×10⁶ MDCs. Preferably 2.0×10⁶ MDCs areadministered in combination with a biocompatible matrix.

For bone augmentation or treatment of bone disorders, the MDCs areprepared as described above and are administered, e.g. in combinationwith a biocompatible matrix at the site of treatment or via injection,onto, into or around bone tissue pretreated with the biocompatiblematrix to provide additional bone density and/or volume. As isappreciated by the skilled practitioner, the number of MDC introduced ismodulated to provide varying amounts of bone density and/or bone volume,as needed or required. In certain embodiments, about 1.0-3.0×10⁶ MDCsare injected for the augmentation of bone in combination with abiocompatible matrix. Thus, the present invention also embraces the useof MDC of the invention in treating bone disorders or enhancing bonedensity and/or bone volume. Bone disorders include osteoporosis, Paget'sDisease, osteogenesis imperfecta, bone fracture, osteomalacia, decreasein bone trabecular strength, decrease in bone cortical strength anddecrease in bone density with old age. The invention also relates to thenovel use of MDCs for the increase of bone mass in athletes or otherorganisms in need of greater than average bone mass.

Biocompatible Matrices

According to some embodiments of the present invention, MDCs are mixedwith the biocompatible matrix material in vitro not long beforeapplication to a tissue or organ site in vivo. Alternatively, MDCs canbe mixed with, or inoculated onto, the biocompatible matrix materialjust at the time of use. In some cases, depending upon cell source, cellconcentration and matrix material, the admixing of MDCs andbiocompatible matrix material, or the inoculation of stem cells ontomatrix material, needs no more time than the time that it takes tocombine the MDCs and the biocompatible matrix at the point of use.

In accordance with the present invention, the in vitro incubation ofMDCs with biocompatible matrix material is performed for from about 5seconds to less than about 12 hours, preferably for from about 5 secondsto about 30 minutes. The in vitro incubation of MDCs with matrixmaterial according to this invention is generally less than about 3hours, preferably, less than about 1 hour, more preferably, less thanabout 30 minutes. In some embodiments of the invention, long-term(e.g., >about 12 hours, days, or weeks) of incubation or culture time isnecessary to achieve results using the combination of MDC-biocompatiblematrix material.

The compositions of the invention can be used in treatments for bonedisorders include osteoporosis, Paget's Disease, osteogenesisimperfecta, bone fracture, osteomalacia, decrease in bone trabecularstrength, decrease in bone cortical strength and decrease in bonedensity with old age.

A variety of biological or synthetic solid matrix materials (i.e., solidsupport matrices, biological adhesives or dressings, andbiological/medical scaffolds) are suitable for use as the biocompatiblematrix of the invention. The biocompatible matrix material is preferablymedically acceptable for use in in vivo applications. Nonlimitingexamples of such medically acceptable and/or biologically orphysiologically acceptable or compatible materials include, but are notlimited to, solid matrix materials that are absorbable and/ornon-absorbable, such as small intestine submucosa (SIS), e.g.,porcine-derived (and other SIS sources); crosslinked or non-crosslinkedalginate, hydrocolloid, foams, collagen gel, collagen sponge,polyglycolic acid (PGA) mesh, polyglactin (PGL) mesh, fleeces, foamdressing, bioadhesives (e.g., fibrin glue and fibrin gel) and deadde-epidermized skin equivalents in one or more layers. As an exemplarybioadhesive, fibrin glue preparations have been described in WO 93/05067to Baxter International, Inc., WO 92/13495 to Fibratek, Inc. WO 91/09641to Cryolife, Inc., and U.S. Pat. Nos. 5,607,694 and 5,631,019 to G.Marx. Preferably, the biocompatible matrix material is SIS.

In an embodiment of the present invention, the biocompatible matrixmaterial can be in the form of a sling, patch, wrap, such as areemployed in surgeries to correct, strengthen, or otherwise repairtissues in need of such treatment.

In another embodiment, the biocompatible matrix, either combined withMDCs or alone, can be applied through a minimally invasive fiberopticscope (e.g., laparoscope) to bone. In another embodiment, thebiocompatible matrix, either combined with MDCs or alone, is applied viaorthopedic endoscopy to coat the outside of damaged or weakened bone ordisc to promote and/or improve healing and strength, and/or to preventdegeneration.

Genetically Engineered Muscle-Derived Cells

In another aspect of the present invention, the MDCs of this inventionmay be genetically engineered to contain a nucleic acid sequence(s)encoding one or more active biomolecules, and to express thesebiomolecules, including proteins, polypeptides, peptides, hormones,metabolites, drugs, enzymes, and the like. Such MDCs may behistocompatible (autologous) or nonhistocompatible (allogeneic) to therecipient, including humans. These cells can serve as long-term localdelivery systems for a variety of treatments, for example, for thetreatment of bone diseases and pathologies, including, but not limitedto osteoporosis, Paget's Disease, osteogenesis imperfecta, bonefracture, osteomalacia, decrease in bone trabecular strength, decreasein bone cortical strength and decrease in bone density with old age.

Preferred in the present invention are autologous muscle-derivedprogenitor cells, which will not be recognized as foreign to therecipient. In this regard, the MDC used for cell-mediated gene transferor delivery will desirably be matched vis-a-vis the majorhistocompatibility locus (MHC or HLA in humans). Such MHC or HLA matchedcells may be autologous. Alternatively, the cells may be from a personhaving the same or a similar MHC or HLA antigen profile. The patient mayalso be tolerized to the allogeneic MHC antigens. The present inventionalso encompasses the use of cells lacking MHC Class I and/or IIantigens, such as described in U.S. Pat. No. 5,538,722, incorporatedherein by reference.

The MDCs may be genetically engineered by a variety of moleculartechniques and methods known to those having skill in the art, forexample, transfection, infection, or transduction. Transduction as usedherein commonly refers to cells that have been genetically engineered tocontain a foreign or heterologous gene via the introduction of a viralor non-viral vector into the cells. Transfection more commonly refers tocells that have been genetically engineered to contain a foreign geneharbored in a plasmid, or non-viral vector. MDCs can be transfected ortransduced by different vectors and thus can serve as gene deliveryvehicles to transfer the expressed products into muscle.

Although viral vectors are preferred, those having skill in the art willappreciate that the genetic engineering of cells to contain nucleic acidsequences encoding desired proteins or polypeptides, cytokines, and thelike, may be carried out by methods known in the art, for example, asdescribed in U.S. Pat. No. 5,538,722, including fusion, transfection,lipofection mediated by the use of liposomes, electroporation,precipitation with DEAE-Dextran or calcium phosphate, particlebombardment (biolistics) with nucleic acid-coated particles (e.g., goldparticles), microinjection, and the like.

Vectors for introducing heterologous (i.e., foreign) nucleic acid (DNAor RNA) into muscle cells for the expression of bioactive products arewell known in the art. Such vectors possess a promoter sequence,preferably, a promoter that is cell-specific and placed upstream of thesequence to be expressed. The vectors may also contain, optionally, oneor more expressible marker genes for expression as an indication ofsuccessful transfection and expression of the nucleic acid sequencescontained in the vector.

Illustrative examples of vehicles or vector constructs for transfectionor infection of the muscle-derived cells of the present inventioninclude replication-defective viral vectors, DNA virus or RNA virus(retrovirus) vectors, such as adenovirus, herpes simplex virus andadeno-associated viral vectors. Adeno-associated virus vectors aresingle stranded and allow the efficient delivery of multiple copies ofnucleic acid to the cell's nucleus. Preferred are adenovirus vectors.The vectors will normally be substantially free of any prokaryotic DNAand may comprise a number of different functional nucleic acidsequences. Examples of such functional sequences include polynucleotide,e.g., DNA or RNA, sequences comprising transcriptional and translationalinitiation and termination regulatory sequences, including promoters(e.g., strong promoters, inducible promoters, and the like) andenhancers which are active in muscle cells.

Also included as part of the functional sequences is an open readingframe (polynucleotide sequence) encoding a protein of interest; flankingsequences may also be included for site-directed integration. In somesituations, the 5′-flanking sequence will allow homologousrecombination, thus changing the nature of the transcriptionalinitiation region, so as to provide for inducible or noninducibletranscription to increase or decrease the level of transcription, as anexample.

In general, the nucleic acid sequence desired to be expressed by themuscle-derived progenitor cell is that of a structural gene, or afunctional fragment, segment or portion of the gene, that isheterologous to the muscle-derived progenitor cell and encodes a desiredprotein or polypeptide product, for example. The encoded and expressedproduct may be intracellular, i.e., retained in the cytoplasm, nucleus,or an organelle of a cell, or may be secreted by the cell. Forsecretion, the natural signal sequence present in the structural genemay be retained, or a signal sequence that is not naturally present inthe structural gene may be used. When the polypeptide or peptide is afragment of a protein that is larger, a signal sequence may be providedso that, upon secretion and processing at the processing site, thedesired protein will have the natural sequence. Examples of genes ofinterest for use in accordance with the present invention include genesencoding cell growth factors, cell differentiation factors, cellsignaling factors and programmed cell death factors. Specific examplesinclude, but are not limited to, genes encoding BMP-2 (rhBMP-2), IL-1Ra,Factor IX, and connexin 43.

As mentioned above, a marker may be present for selection of cellscontaining the vector construct. The marker may be an inducible ornon-inducible gene and will generally allow for positive selection underinduction, or without induction, respectively. Examples of commonly-usedmarker genes include neomycin, dihydrofolate reductase, glutaminesynthetase, and the like.

The vector employed will generally also include an origin of replicationand other genes that are necessary for replication in the host cells, asroutinely employed by those having skill in the art. As an example, thereplication system comprising the origin of replication and any proteinsassociated with replication encoded by a particular virus may beincluded as part of the construct. The replication system must beselected so that the genes encoding products necessary for replicationdo not ultimately transform the muscle-derived cells. Such replicationsystems are represented by replication-defective adenovirus constructedas described, for example, by G. Acsadi et al., 1994, Hum. Mol. Genet3:579 584, and by Epstein-Barr virus. Examples of replication defectivevectors, particularly, retroviral vectors that are replicationdefective, are BAG, described by Price et al., 1987, Proc. Natl. Acad.Sci. USA, 84:156; and Sanes et al., 1986, EMBO J., 5:3133. It will beunderstood that the final gene construct may contain one or more genesof interest, for example, a gene encoding a bioactive metabolicmolecule. In addition, cDNA, synthetically produced DNA or chromosomalDNA may be employed utilizing methods and protocols known and practicedby those having skill in the art.

If desired, infectious replication-defective viral vectors may be usedto genetically engineer the cells prior to in vivo injection of thecells. In this regard, the vectors may be introduced into retroviralproducer cells for amphotrophic packaging. The natural expansion ofmuscle-derived progenitor cells into adjacent regions obviates a largenumber of injections into or at the site(s) of interest.

In another aspect, the present invention provides ex vivo gene deliveryto cells and tissues of a recipient mammalian host, including humans,through the use of MDC, e.g., early progenitor muscle cells, that havebeen virally transduced using an adenoviral vector engineered to containa heterologous gene encoding a desired gene product. Such an ex vivoapproach provides the advantage of efficient viral gene transfer, whichis superior to direct gene transfer approaches. The ex vivo procedureinvolves the use of the muscle-derived progenitor cells from isolatedcells of muscle tissue. The muscle biopsy that will serve as the sourceof muscle-derived progenitor cells can be obtained from an injury siteor from another area that may be more easily obtainable from theclinical surgeon.

It will be appreciated that in accordance with the present invention,clonal isolates can be derived from the population of muscle-derivedprogenitor cells (i.e., PP6 cells or “slowly adhering” cells using thesingle plate procedure) using various procedures known in the art, forexample, limiting dilution plating in tissue culture medium. Clonalisolates comprise genetically identical cells that originate from asingle, solitary cell. In addition, clonal isolates can be derived usingFACS analysis as described above, followed by limiting dilution toachieve a single cell per well to establish a clonally isolated cellline. An example of a clonal isolate derived from the PP6 cellpopulation is mc13, which is described in Example 1. Preferably, MDCclonal isolates are utilized in the present methods, as well as forgenetic engineering for the expression of one or more bioactivemolecules, or in gene replacement therapies.

The MDCs are first infected with engineered viral vectors containing atleast one heterologous gene encoding a desired gene product, suspendedin a physiologically acceptable carrier or excipient, such as saline orphosphate buffered saline, and then administered to an appropriate sitein the host. Consistent with the present invention, the MDCs can beadministered to body tissues, including bone, as described above. Thedesired gene product is expressed by the injected cells, which thusintroduce the gene product into the host. The introduced and expressedgene products can thereby be utilized to treat, repair, or amelioratethe injury, dysfunction, or disease, due to their being expressed overlong time periods by the MDCs of the invention, having long-termsurvival in the host.

In animal model studies of myoblast-mediated gene therapy, implantationof 10⁶ myoblasts per 100 mg muscle was required for partial correctionof muscle enzyme defects (see, J. E. Morgan et al., 1988, J. Neural.Sci. 86:137; T. A. Partridge et al., 1989, Nature 337:176).Extrapolating from this data, approximately 10¹² MDCs suspended in aphysiologically compatible medium can be implanted into muscle tissuefor gene therapy for a 70 kg human. This number of MDC of the inventioncan be produced from a single 100 mg skeletal muscle biopsy from a humansource (see below). For the treatment of a specific injury site, aninjection of genetically engineered MDC into a given tissue or site ofinjury comprises a therapeutically effective amount of cells in solutionor suspension, preferably, about 10⁵ to 10⁶ cells per cm³ of tissue tobe treated, in a physiologically acceptable medium.

EXAMPLES Example 1. MDC Enrichment, Isolation and Analysis According tothe Pre-Plating Method

MDCs were prepared as described (U.S. Pat. No. 6,866,842 of Chancelloret al.). Muscle explants were obtained from the hind limbs of a numberof sources, namely from 3-week-old mdx (dystrophic) mice (C57BL/10ScSnmdx/mdx, Jackson Laboratories), 4-6 week-old normal female SD (SpragueDawley) rats, or SCID (severe combined immunodeficiency) mice. Themuscle tissue from each of the animal sources was dissected to removeany bones and minced into a slurry. The slurry was then digested by 1hour serial incubations with 0.2% type XI collagenase, dispase (gradeII, 240 unit), and 0.1% trypsin at 37° C. The resulting cell suspensionwas passed through 18, 20, and 22 gauge needles and centrifuged at 3000rpm for 5 minutes. Subsequently, cells were suspended in growth medium(DMEM supplemented with 10% fetal bovine serum, 10% horse serum, 0.5%chick embryo extract, and 2% penicillin/streptomycin). Cells were thenpreplated in collagen-coated flasks (U.S. Pat. No. 6,866,842 ofChancellor et al.). After approximately 1 hour, the supernatant wasremoved from the flask and re-plated into a fresh collagen-coated flask.The cells which adhered rapidly within this 1 hour incubation weremostly fibroblasts (Z. Qu et al., supra; U.S. Pat. No. 6,866,842 ofChancellor et al.). The supernatant was removed and re-plated after30-40% of the cells had adhered to each flask. After approximately 5-6serial platings, the culture was enriched with small, round cells,designated as PP6 cells, which were isolated from the starting cellpopulation and used in further studies. The adherent cells isolated inthe early platings were pooled together and designated as PP1-4 cells.

The mdx PP1-4, mdx PP6, normal PP6, and fibroblast cell populations wereexamined by immunohistochemical analysis for the expression of cellmarkers. The results of this analysis are shown in Table 1.

TABLE 1 Cell markers expressed in PP1-4 and PP6 cell populations. mdxPP1-4 mdx PP6 nor PP6 cells cells cells fibroblasts desmin +/− + + −CD34 − + + − Bcl-2 (−) + + − Flk-1 na + + − Sca-1 na + + − M-cadherin−/+ −/+ −/+ − MyoD −/+ +/− +/− − myogenin −/+ +/− +/− −

Mdx PP1-4, mdx PP6, normal PP6, and fibroblast cells were derived bypreplating technique and examined by immunohistochemical analysis. “−”indicates less than 2% of the cells showed expression; “(−)”; “−/+”indicates 5-50% of the cells showed expression; “+/−” indicates ˜40-80%of the cells showed expression; “+” indicates that >95% of the cellsshowed expression; “nor” indicates normal cells; “na” indicates that theimmunohistochemical data is not available.

It is noted that both mdx and normal mice showed identical distributionof all the cell markers tested in this assay. Thus, the presence of themdx mutation does not affect the cell marker expression of the isolatedPP6 muscle-cell derived population.

MDCs were grown in proliferation medium containing DMEM (Dulbecco'sModified Eagle Medium) with 10% FBS (fetal bovine serum), 10% HS (horseserum), 0.5% chick embryo extract, and 1% penicillin/streptomycin, orfusion medium containing DMEM supplemented with 2% fetal bovine serumand 1% antibiotic solution. All media supplies were purchased throughGibco Laboratories (Grand Island, N.Y.).

Example 2. MDC Enrichment, Isolation and Analysis According to theSingle Plate Method

Populations of rapidly- and slowly-adhering MDCs were isolated fromskeletal muscle of a mammalian subject. The subject may be a human, rat,dog or other mammal. Biopsy size ranged from 42 to 247 mg.

Skeletal muscle biopsy tissue is immediately placed in cold hypothermicmedium (HYPOTHERMOSOL® (BioLife) supplemented with gentamicin sulfate(100 ng/ml, Roche)) and stored at 4° C. After 3 to 7 days, biopsy tissueis removed from storage and production is initiated. Any connective ornon-muscle tissue is dissected from the biopsy sample. The remainingmuscle tissue that is used for isolation is weighed. The tissue isminced in Hank's Balanced Salt Solution (HBSS), transferred to a conicaltube, and centrifuged (2,500×g, 5 minutes). The pellet is thenresuspended in a Digestion Enzyme solution (Liberase Blendzyme 4(0.4-1.0 U/mL, Roche)). 2 mL of Digestion Enzyme solution is used per100 mg of biopsy tissue and is incubated for 30 minutes at 37° C. on arotating plate. The sample is then centrifuged (2,500×g, 5 minutes). Thepellet is resuspended in culture medium and passed through a 70 μm cellstrainer. The culture media used for the procedures described in thisExample was Cambrex Endothelial Growth Medium EGM-2 basal mediumsupplemented with the following components: i. 10% (v/v) fetal bovineserum, and ii. Cambrex EGM-2 SingleQuot Kit, which contains: InsulinGrowth Factor-1 (IGF-1), Basic Fibroblast Growth Factor (bFGF), VascularEndothelial Growth Factor (VEGF), Epidermal Growth Factor (EGF),Hydrocortisone, Heparin, and Ascorbic Acid. The filtered cell solutionis then transferred to a T25 culture flask and incubated for 30-120minutes at 37° C. in 5% CO₂. Cells that attach to this flask are the“rapidly-adhering cells”.

After incubation, the cell culture supernatant is removed from the T25flask and placed into a 15 mL conical tube. The T25 culture flask isrinsed with 2 mL of warmed culture medium and transferred to theaforementioned 15 mL conical tube. The 15 mL conical tube is centrifuged(2,500×g, 5 minutes). The pellet is resuspended in culture medium andtransferred to a new T25 culture flask. The flask is incubated for ˜2days at 37° C. in 5% CO2 (cells that attach to this flask are the“slowly-adhering cells”). After incubation, the cell culture supernatantis aspirated and new culture medium is added to the flask. The flask isthen returned to the incubator for expansion. Standard culture passagingis carried out from here on to maintain the cell confluency in theculture flask at less than 50%. Trypsin-EDTA (0.25%, Invitrogen) is usedto detach the adherent cells from the flask during passage. Typicalexpansion of the “slowly-adhering cells” takes an average of 17 days(starting from the day production is initiated) to achieve an averagetotal viable cell number of 37 million cells.

Once the desired cell number is achieved, the cells are harvested fromthe flask using Trypsin-EDTA and centrifuged (2,500×g, 5 minutes). Thepellet is resuspended in BSS-P solution (HBSS supplemented with humanserum albumin (2% v/v, Sera Care Life)) and counted. The cell solutionis then centrifuged again (2,500×g, 5 minutes), resuspended withCryopreservation Medium (CryoStor (Biolife) supplemented with humanserum albumin (2% v/v, Sera Care Life Sciences)) to the desired cellconcentration, and packaged in the appropriate vial for cryogenicstorage. The cryovial is placed into a freezing container and placed inthe −80° C. freezer. Cells are administered by thawing the frozen cellsuspension at room temperature with an equal volume of physiologicsaline and injected directly (without additional manipulation). Thelineage characterization of the slowly adhering cell populations shows:Myogenic (87.4% CD56+, 89.2% desmin+), Endothelial (0.0% CD31+),Hematopoietic (0.3% CD45+), and Fibroblast (6.8% CD90+/CD56-).

Following disassociation of the skeletal muscle biopsy tissue, twofractions of cells were collected based on their rapid or slow adhesionto the culture flasks. The cells were then expanded in culture withgrowth medium and then frozen in cryopreservation medium (3×10⁵ cells in15 μl) in a 1.5 ml eppendorf tube. For the control group, 15 μl ofcryopreservation medium alone was placed into the tube. These tubes werestored at −80° C. until injection. Immediately prior to injection, atube was removed from storage, thawed at room temperature, andresuspended with 15 μl of 0.9% sodium chloride solution.

Cell count and viability was measured using a Guava flow cytometer andViacount assay kit (Guava). CD56 was measured by flow cytometry (Guava)using PE-conjugated anti-CD56 antibody (1:50, BD Pharmingen) andPE-conjugated isotype control monoclonal antibody (1:50, BD Pharmingen).Desmin was measured by flow cytometry (Guava) on paraformaldehyde-fixedcells (BD Pharmingen) using a monoclonal desmin antibody (1:100, Dako)and an isotype control monoclonal antibody (1:200, BD Pharmingen).Fluorescent labeling was performed using a Cy3-conjugated anti-mouse IgGantibody (1:250, Sigma). In between steps, the cells were washed withpermeabilization buffer (BD Pharmingen). For creatine kinase (CK) assay,1×10⁵ cells were plated per well into a 12 well plate indifferentiation-inducing medium. Four to 6 days later, the cells wereharvested by trypsinization and centrifuged into a pellet. The celllysis supernatant was assayed for CK activity using the CK Liqui-UV kit(Stanbio).

Example 3. Small Intestine Submucosa Alleviates the Repair of a CriticalSize Calvarial Defect in Mice

The purpose of this study was to investigate the bone regenerativepotential of single-layer SIS scaffold transplanted into critical sizecalvarial defect in mice. We also preconditioned SIS grafts by seedingthem with human muscle-derived cells (hMDCs), prepared as detailed inExample 2, above, in order to test osteogenic potential of thisconstruct in response to natural fracture environment.

Materials and Methods

In this study a total of 24 SCID mice were used. All animal experimentswere approved by institutional ARCC. Surgical procedure was performedunder general anesthesia. Critical size calvarial bone defect wascreated using a 5-mm-diameter trephine burr. Human muscle-derived cells(hMDCs) isolated from a 35 year old male patient were provided. Animalswere divided into 3 groups according to the treatment they received. Acontrol group consisted of untreated mice with a calvarial defect voidof cells or SIS. The second group consisted of mice receiving 5×5 mmsingle layer of SIS sheet (Cook Biotech, Inc) without cells that wasplaced on top of the defect. The third group consisted of mice receiving5×5 mm single layer SIS sheet that was seeded with 2×10⁶ humanmuscle-derived cells hMDCs twelve hours before transplantation.Microcomputed tomography (vivaCT40, Scanco) of the calvaria wasperformed on the following day after the surgery for each animal. Fouranimals in each group were sacrificed at 4 and 10 weeks and harvestedcalvaria were evaluated by microCT for a new bone formation. Specimenswere fixed in 10% neutral buffered formalin and preserved for laterhistological analysis.

Results

3D reconstruction of the untreated calvaria did not revealed anysubstantial bone formation within the defects at 4 and 10 weeks (FIGS.1A and 1D). Bone regeneration was seen only along the rim of the defectwhich remained entirely open and did not contain any islands of newbone. At 4 weeks the calvarial defects that were treated with SIS sheetwithout cells contained very small or undetectable bone formation mostlyalong the edge of the defect (FIG. 1B). At the same time defects treatedwith SIS sheet seeded with hMDCs contained obvious islands of newlyformed bone (FIG. 1C). At 10 weeks we detected large islands of new bonein both SIS, and SIS-hMDC-treated calvarial defects (FIGS. 1E and 1F).Quantification of new bone within volume of interest (VOI) using Scancoimaging software revealed difference between control-untreated andSIS-treated defects at 4 and 10 weeks (FIG. 2). At 4 weeks the new bonevolume was 0.01±0.005 mm³ in the control group, 0.16±0.15 mm³ in theSIS-treated group, and 0.4±0.27 mm³ in the SIS-hMDC-treated group. At 10weeks the new bone volume increased up to 0.02±0.02 mm³ in the controlgroup, 1.11±0.73 mm³ in the SIS-treated group, and 1.38±1.02 mm³ in theSIS-hMDC-treated group. The SIS-hMDC treatment group had significantlymore bone at 4 and 10 weeks compared to the empty (untreated) group.Also, there was significant increase in bone volume in the SIS-treatedgroup at 10 weeks compared to the 4 week time point. FIG. 3 containsimportant information and supports our previous results showingsignificant difference in bony bridging score between theSIS-hMDC-treated group and the empty group at 4 and 10 weeks. (Patel etal. Bone, 43:931-940 (2008), provides methods for determining a bonybridging score and is incorporated herein by reference in its entirety).The data suggests that the combination of MDCs with SIS administered tosubjects leads to faster healing of bone.

Discussion

This study demonstrated that SIS grafts function as a regenerativematrix scaffold, guiding the attachment of host cells and supportingformation of new bone. Enhanced bone formation was observed inSIS-treated calvarial defects in mice, while control untreated defectsshowed only minimal calcification Bone formation in SIS-treatedcalvarias was already visible after 4 weeks and gradually increased over10 week period. Addition of human muscle-derived cells to the SIS graftsapparently enhanced calvarial defect healing.

Example 4. hMDCs Seeded on SIS Undergo Osteogenesis In Vitro Methods

2×10⁶ human muscle-derived cells were seeded on pre-cut 6 mm diameter 4layer SIS disks and incubated for 28 days in either proliferation medium(n=3) containing phenol red-free Dulbecco's Modified Eagle's Medium(DMEM) (Invitrogen) supplemented with 110 mg/L sodium pyruvate(Sigma-Aldrich), 584 mg/L L-Glutamine, 10% fetal bovine serum (FBS), 10%horse serum (HS), 1% penicillin/streptomycin (all from Invitrogen), and0.5% chick embryo extract (Accurate Chemical Co.), or osteogenic medium(n=6) containing phenol-red free DMEM, 10% FBS, 1%Penicillin/streptomycin, 10-7 M dexamethasone, 5×10⁻⁵ Mascorbic-acid-2-phosphate, 10⁻² M β-glycerophosphate]. at 36° C. in thepresence of 5% CO₂ with medium change every 2-3 days. SIS scaffoldswithout cells were used for the control and cultivated similarly ineither osteogenic (n=6) or proliferation (n=4) medium. The same humancells were used to make four cell pellets (250,000 cells/pellet) thatwere incubated for 28 days in osteogenic medium. All scaffolds and cellpellets undergo micro-CT scanning at 7, 10, 14, 21, and 28 days and wereevaluated for mineralized matrix volume and density.

Results:

3D reconstruction by micro-CT revealed presence of mineralization asearly as 7 days in human cell-populated SIS scaffolds cultured inosteogenic medium. The mineralized matrix volume in this groupprogressively increased from 0.112±0.09 mm³, as observed at 7 days, to4.673±0.72 mm³, as detected at 28 days (FIG. 4A). No matrixmineralization during the entire culture period was detected in SISscaffolds containing human cells that were placed in proliferationmedium. Empty SIS scaffolds containing no cells also exhibited mineraldeposition at 21 days (0.162±0.19 mm³) and 28 days (1.329±0.8 mm³) whencultured in osteogenic medium, but did not conduce to mineralizationwhen cultivated in proliferation medium. The mineralized matrix densityin SIS scaffolds with human cells cultivated in osteogenic medium was222.31±35.7 mm HA/ccm at 7 days, and slightly decreased to 200.05±25.4mm HA/ccm at 28 days (FIG. 4B). Density of empty SIS scaffolds culturedin OSM was 157.09±7.2 mm HA/ccm at 21 day and 170.05±20.12 mm HA/ccm at28 days (FIG. 4B). FIG. 5 shows 3D micro-CT reconstruction of SIS andSIS-hMDC scaffolds (5 samples in each group) cultured in osteogenicmedium on day 28. It demonstrates that hMDC-seeded SIS scaffolds havemore intense mineralization than SIS scaffolds without cells suggestingthat hMDCs accelerated the formation of mineralized matrix on SISsheets.

Micro-CT scanning of human cell pellets cultured in osteogenic mediumrevealed matrix mineralization to a lesser extent. The initial matrixvolume detected at 7 days (0.221±0.004 mm³) was merely increased at 28days (0.31±0.06 mm³) (FIG. 6A). However, mineralized matrix density inpellet cultures increased noticeably. It was 252.2±9.96 mg HA/ccm at 7days, 445.34±22.55 mg HA/ccm at 14 days, and 609.01±42.82 mm HA/ccm at28 days (FIG. 6B).

We do not wish to be limited by theory, however, the effect of increasedvolume produced when using SIS and increased density when using pelletscould be caused by the difference of the cells being spread out on SISas opposed to compacted into a tight pellet. The cells on SIS are spreadout and are simply creating bone over the entire SIS area. Thus, theeffect seen is increased bone volume during the period of evaluation.Whereas, the cells in pellet are compacted into a small area andtherefore are just increasing in density over the period of evaluation.Arguably, there is really no room for much volume increase since theyare already in a pellet.

What is claimed is: 1.-34. (canceled)
 35. A method of treating a bonedisease, defect or pathology in a human subject in need thereof, whereinthe method comprises administering to the human subject small intestinesubmucosa (SIS) seeded with a cell population enriched for musclederived progenitor cells (MDCs), wherein the cell population enrichedfor MDCs is isolated from skeletal muscle by a method comprising: a.suspending skeletal muscle cells obtained from the human in a first cellculture container for between 30 and 120 minutes to produce a populationof adherent cells and a population of non-adherent cells; b. decantingmedia and the population of non-adherent cells from the first cellculture container to a second cell culture container; c. allowing thepopulation of decanted, non-adherent cells in the media to attach to thewalls of the second cell culture container; and d. isolating thepopulation of cells from the walls of the second cell culture container,wherein the isolated population of cells is the cell population enrichedfor MDCs.
 36. The method of claim 35, wherein the isolation methodfurther comprises culturing the cell population enriched for MDCs toexpand their number before being used to seed the SIS.
 37. The method ofclaim 36, wherein the expanded cell population enriched for MDCs isfrozen to a temperature below −30° C. after being cultured to expandtheir number and thawed prior to being used to seed SIS.
 38. The methodof claim 35, wherein the isolation method further comprises cooling theskeletal muscle cells obtained from the human to a temperature below 10°C. and storing for 1-7 days before being suspended in a first cellculture container for between 30 and 120 minutes.
 39. The method ofclaim 35, wherein treating a bone disease, defect or pathology comprisesaugmenting bone.
 40. The method of claim 35, wherein treating a bonedisease, defect or pathology comprises increasing bone volume or bonedensity.
 41. The method of claim 35, wherein treating a bone disease,defect or pathology comprises treatment of osteoporosis, Paget'sDisease, osteogenesis imperfecta, bone fracture, osteomalacia, decreasein bone trabecular strength, decrease in bone cortical strength, ordecrease in bone density with old age.
 42. The method of claim 35,wherein the bone defect is a bone fracture caused by trauma.
 43. Themethod of claim 35, wherein the SIS seeded with a cell populationenriched for MDCs is administered by applying it to the surface of thebone.
 44. The method of claim 35, wherein the SIS seeded with a cellpopulation enriched for MDCs is positioned in the interior of the bone.